SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

SKELETAL SURGERY FOR OBSTRUCTIVE SLEEP APNEA SYNDROME

Burak Hazır

Ankara Bilkent City Hospital, Department of Otorhinolaryngology, Ankara, Türkiye

Hazır B. Skeletal Surgery for Obstructive Sleep Apnea Syndrome. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.185-191.

ABSTRACT

Obstructive sleep apnea syndrome is a frequently encountered sleep-related breathing disorder characterized by recurrent narrowing or complete obstruction of the upper airway during sleep, leading to significant cardiovascular, metabolic, and neuropsychiatric consequences. While positive airway pressure therapy remains the first-line treatment, surgical interventions have become increasingly relevant in patients with poor positive airway pressure therapy compliance or anatomical abnormalities. The first surgical intervention described for the treatment of obstructive sleep apnea was tracheotomy. Subsequently, less invasive surgical techniques targeting upper airway soft tissues were described. Among these, uvulopalatopharyngoplasty became the most popular and frequently performed soft tissue surgeries for obstructive sleep apnea. On the other hand, long-term observational studies have shown that the effectiveness of soft tissue surgeries may be limited, particularly in certain patient populations. Therefore, this chapter provides a comprehensive overview of skeletal framework surgeries for obstructive sleep apnea, including transpalatal advancement pharyngoplasty, genioglossus advancement procedure, hyoid suspension procedure, and maxillo-mandibular advancement procedure. Each surgical procedure is discussed in terms of anatomical targets, surgical technique, indications, efficacy, and potential complications. Transpalatal advancement pharyngoplasty addresses retropalatal collapse by advancing the soft palate anteriorly, whereas genioglossus advancement procedure targets obstruction caused by the tongue base by repositioning the genioglossus muscle. Hyoid suspension procedure stabilizes the hypopharyngeal airway via anterior repositioning of the hyoid bone. Maxillo-mandibular advancement procedure, which is the most extensive of the all skeletal surgery procedures, repositions both the maxillae and mandible anteriorly to enlarge the entire upper airway and has demonstrated the highest success rates, particularly in patients with severe obstructive sleep apnea and / or craniofacial abnormalities. Anatomic considerations, patient selection, and perioperative management are also important to optimize patient outcomes. Collectively, skeletal surgeries represent important critical tools in the multidisciplinary management of obstructive sleep apnea syndrome, particularly in the patients with multi-level airway collapse or structural compromise.

Keywords: Sleep apnea syndromes; Sleep apnea; Obstructive; Maxilla; Mandible

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